Viral Sepsis in Children

Gupta, Neha; Richter, Robert; Robert, Stephen; Kong, Michele

Sepsis from HPeV can lead to significant morbidity in neonates and young children. Although, most infections are self-limited, long-term neurological deficits such as learning disability, developmental delay, paralysis and epilepsy have been observed in these patients (179, 180) . HPeV infections have also been associated with encephalitis, hepatitis and coagulopathy (18) . In addition, rare complications have also been observed in these patients including necrotizing enterocolitis, myocarditis, myositis, hemolytic uremic syndrome, and Reye's syndrome (18) . Other enteroviral infections can lead to similar complications and long-term neurological deficits. Hepatic and cardiac dysfunction can also be observed in these patients (181) (182) (183) . In HSV infection, neurological complications such as developmental delay and seizures have been observed in infected neonates (15) . Mortality from systemic HSV infection is usually due to severe coagulopathy, hepatitis and pneumonitis (15) . In a multicenter study, Spaeder et al. observed a mortality rate of 9% in patients with severe metapneumovirus infection (184) . Increased mortality from metapneumovirus infection has been observed in children with chronic medical conditions, female gender and patients who acquired the infection in the hospital (184) . Similarly, RSV, parainfluenza and influenza infections, when acquired in hospital, have been associated with increased mortality (185) . Rotavirus infection can lead to extraintestinal complications like seizures and meningoencephalitis (186, 187) . In HIV patients, likelihood of progression to AIDS and of mortality are impacted by time of acquisition of HIV, viral load, CD4 count and timing of HAART initiation. Approximately 80% mortality has been observed in developing countries with limited access to HAART (188) . Complications that lead to increased morbidity and mortality in these patients include severe CMV infection, encephalopathy, recurrent life-threatening bacterial infections, tuberculosis, and pneumocystis infection (189) .